A 31-year-old woman is examined by an otolaryngologist pur-suant to her complaint of hearing difficulties.The physicianplaces a tuning fork against the woman’s mastoid bone untilshe no longer perceives sound,then moves the prongs to herexternal ear where a faint sound is again heard.This maneuveris best described as:

A.&nbsp

A negative (abnormal) Rinne test

B.&nbsp

A normal Binet test

C.&nbsp

A normal Weber test

D.&nbsp

A positive (normal) Rinne test

E.&nbsp

Weber test localizing to the deaf side

2.

A 64-year-old man is brought to a rural health clinic by a neigh-bor.The history reveals that the man is a recluse,lives by him-self,and does not regularly visit a physician.The examinationreveals that the man has difficulty walking,chorea and dysto-nia,and is suffering dementia.The neighbor believes that theman’s father died from a similar disease.A tentative diagnosisof Huntington disease is made.Absence of which of the follow-ing structures in an MRI of this man would be consistent withthis diagnosis?

A.&nbsp

Anterior lobe of cerebellum

B.&nbsp

Head of the caudate

C.&nbsp

Lateral thalamic nuclei

D.&nbsp

Substantia nigra

E.&nbsp

Subthalamic nucleus

3.

A 23-year-old man is brought to the emergency departmentfrom an accident at a construction site.CT shows a fracture ofthe left mastoid bone with total disruption of the stylomastoidforamen.Which of the following deficits would most likely beseen in this man?

A.&nbsp

Alternating hemianesthesia

B.&nbsp

Alternating hemiplegia

C.&nbsp

Central seven

D.&nbsp

Facial hemiplegia

E.&nbsp

Hemifacial spasm

4.

Cell bodies located in which of the following ganglia of thehead supply postganglionic fibers to the parotid gland?

A.&nbsp

Ciliary

B.&nbsp

Intramural

C.&nbsp

Otic

D.&nbsp

Pterygopalatine

E.&nbsp

Submandibular

5.

A 23-year-old man is brought to the emergency department fromthe site of an automobile collision.CT shows fractures of the facialbones and evidence of bilateral trauma to the temporal lobes(blood in the substance of the brain).
As this man recovers,which of the following deficits is mostlikely to be the most obvious?

A.&nbsp

A bilateral sensory loss in the lower body

B.&nbsp

A loss of immediate and short-term memory

C.&nbsp

A loss of long-term (remote) memory

D.&nbsp

Dementia

E.&nbsp

Dysphagia and dysarthria

6.

A 23-year-old man is brought to the emergency department fromthe site of an automobile collision.CT shows fractures of the facialbones and evidence of bilateral trauma to the temporal lobes(blood in the substance of the brain).
Assuming that this man also has sustained bilateral injury tothe Meyer-Archambault loop,which of the following deficitswould he also most likely have?

A.&nbsp

Bitemporal hemianopsia

B.&nbsp

Bilateral inferior quadrantanopia

C.&nbsp

Bilateral superior quadrantanopia

D.&nbsp

Left superior quadrantanopia

E.&nbsp

Right superior quadrantanopia

7.

A 59-year-old man,who is a family physician,confides in a neu-rology colleague that he believes he has early-stage Parkinsondisease.The neurological examination reveals a slight resting tremor of the left hand,slow gait,and lack of the normal rangeof facial expression.Which of the following is the most likelylocation of the degenerative changes at this stage of the physi-cian’s disease?

A.&nbsp

Bilateral substantia nigra

B.&nbsp

Left globus pallidus

C.&nbsp

Left substantia nigra

D.&nbsp

Right globus pallidus

E.&nbsp

Right substantia nigra

8.

A 14-year-old boy is brought to the emergency departmentafter an accident on his BMX bicycle.The examination revealsthat the boy has severe facial injuries.Craniofacial CT showsfracture of facial bones and probable crushing of the structurestraversing the superior orbital fissure.Damage to which of thefollowing structures passing through this fissure would resultin diplopia when attempting to look down and in?

A.&nbsp

Abducens nerve

B.&nbsp

Oculomotor nerve

C.&nbsp

Ophthalmic nerve

D.&nbsp

Ophthalmic vein

E.&nbsp

Trochlear nerve

9.

A 67-year-old man is brought to the emergency department by hiswife.She explains that he fell suddenly,could not get out of his bed,and complained of feeling sick.The examination revealed a left-sided weakness of the upper and lower extremities,a lack of mostmovement of the right eye,and a dilated pupil on the right.MRIshows an infarcted area in the brainstem.
The weakness of this man’s extremities is explained by damageto the axons of cell bodies that are located in which of the fol-lowing regions of the brain?

A.&nbsp

Left somatomotor cortex

B.&nbsp

Right anterior paracentral gyrus

C.&nbsp

Right crus cerebri

D.&nbsp

Right precentral gyrus

E.&nbsp

Right somatomotor cortex

10.

A 67-year-old man is brought to the emergency department by hiswife.She explains that he fell suddenly,could not get out of his bed,and complained of feeling sick.The examination revealed a left-sided weakness of the upper and lower extremities,a lack of mostmovement of the right eye,and a dilated pupil on the right.MRIshows an infarcted area in the brainstem.
This man’s dilated pupil is due to damage to which of the fol-lowing fiber populations?

A.&nbsp

Preganglionic fibers from the Edinger-Westphal nucleus

B.&nbsp

Preganglionic fibers from the inferior salivatory nucleus

C.&nbsp

Postganglionic fibers from the ciliary ganglion

D.&nbsp

Postganglionic fibers from the geniculate ganglion

E.&nbsp

Postganglionic fibers from the superior cervical ganglion

11.

A 67-year-old man is brought to the emergency department by hiswife.She explains that he fell suddenly,could not get out of his bed,and complained of feeling sick.The examination revealed a left-sided weakness of the upper and lower extremities,a lack of mostmovement of the right eye,and a dilated pupil on the right.MRIshows an infarcted area in the brainstem.
Which of the following descriptive phrases best describes theconstellation of signs and symptoms seen in this man?

A.&nbsp

Alternating hemianesthesia

B.&nbsp

Brown-Séquard syndrome

C.&nbsp

Inferior alternating hemiplegia

D.&nbsp

Middle alternating hemiplegia

E.&nbsp

Superior alternating hemiplegia

12.

Which of the following structures contains the cell bodies oforigin for fibers conveying taste information from the anteriortwo-thirds of the tongue?

A.&nbsp

Ciliary ganglion

B.&nbsp

Geniculate ganglion

C.&nbsp

Superior ganglion of the vagus nerve

D.&nbsp

Superior ganglion of the glossopharyngeal nerve

E.&nbsp

Trigeminal ganglion

13.

During a screening neurological examination of a 39-year-oldman,the physician taps the supraorbital ridge,stimulating thesupraorbital nerve,and elicits a motor response.Which of thefollowing most likely represents the motor response in thisman?

A.&nbsp

Constriction of the masticatory muscles

B.&nbsp

Constriction of the orbicularis oculi muscle

C.&nbsp

Constriction of the pupil

D.&nbsp

Dilation of the pupil

E.&nbsp

Horizontal nystagmus

14.

A 67-year-old man has a bilateral anterolateral cordotomy atT10 for intractable pelvic pain.Four months after this proce-dure the man begins to experience pain sensations.Which ofthe following would most likely explain the apparent recur-rence of pain in this man?

Regeneration of anterolateral system fibers into the pos-terior column system

15.

An 84-year-old woman presents to her physician with the com-plaint of difficulty walking.The examination reveals that thewoman has an unsteady gait and tends to forcibly slap her feetto the floor as she walks.She has no other deficits.The physi-cian concludes that the woman has sensory ataxia.Degenerative changes in which of the following would mostlikely explain this deficit?

A.&nbsp

Anterolateral system fibers

B.&nbsp

Corticospinal fibers

C.&nbsp

Posterior column fibers

D.&nbsp

Posterior root fibers

E.&nbsp

Vestibulospinal and reticulospinal fibers

16.

A 70-year-old woman is brought to the emergency department byher daughter after becoming ill during a trip to the mall.Thewoman is conscious but lethargic,and she has trouble speakingand swallowing.The examination reveals a loss of pain and ther-mal sensation on the left side of the face and a hoarse gravely voice(as if the woman has a sore throat).Movements of the extremitiesare normal for the woman’s age,but she has a loss of pain and ther-mal sensations on the right side of her body.The corneal reflex isabsent on the left side.MRI shows an infarcted area in the brain-stem.
The facial sensory deficits experienced by this woman areexplained by a lesion to the axons of cell bodies located inwhich of the following structures?

A.&nbsp

Anterior trigeminothalamic fibers on the left

B.&nbsp

Left trigeminal ganglion

C.&nbsp

Principal sensory nucleus on the left

D.&nbsp

Right trigeminal ganglion

E.&nbsp

Spinal trigeminal nucleus on the right

17.

A 70-year-old woman is brought to the emergency department byher daughter after becoming ill during a trip to the mall.Thewoman is conscious but lethargic,and she has trouble speakingand swallowing.The examination reveals a loss of pain and ther-mal sensation on the left side of the face and a hoarse gravely voice(as if the woman has a sore throat).Movements of the extremitiesare normal for the woman’s age,but she has a loss of pain and ther-mal sensations on the right side of her body.The corneal reflex isabsent on the left side.MRI shows an infarcted area in the brain-stem.
The loss of pain and thermal sensations experienced by thiswoman on the right side of her body (excluding the face) ismost likely the result of damage to which of the followingstructures?

A.&nbsp

Anterolateral system fibers on the left

B.&nbsp

Anterolateral system fibers on the right

C.&nbsp

Anterior trigeminothalamic fibers on the left

D.&nbsp

Medial lemniscus on the left

E.&nbsp

Medial lemniscus on the right

18.

A 70-year-old woman is brought to the emergency department byher daughter after becoming ill during a trip to the mall.Thewoman is conscious but lethargic,and she has trouble speakingand swallowing.The examination reveals a loss of pain and ther-mal sensation on the left side of the face and a hoarse gravely voice(as if the woman has a sore throat).Movements of the extremitiesare normal for the woman’s age,but she has a loss of pain and ther-mal sensations on the right side of her body.The corneal reflex isabsent on the left side.MRI shows an infarcted area in the brain-stem.
Taking into account all the deficits experienced by this woman,which of the following characterizes the syndrome,and theside,in this patient?

A.&nbsp

Benedikt syndrome on the left

B.&nbsp

Lateral medullary syndrome on the left

C.&nbsp

Lateral medullary syndrome on the right

D.&nbsp

Parinaud syndrome (bilateral)

E.&nbsp

Weber syndrome on the right

19.

A 17-year-old boy from a poor rural community is diagnosedwith hepatolenticular degeneration (Wilson disease).Which ofthe following is accumulating in certain tissues of his body andproducing health problems?

A.&nbsp

Arsenic

B.&nbsp

Copper

C.&nbsp

Lead

D.&nbsp

Magnesium

E.&nbsp

Mercury

20.

Which of the following represents the location of the postgan-glionic fibers that influence the dilator pupillae muscle of theiris on the ipsilateral side?

A.&nbsp

Ciliary ganglion

B.&nbsp

Edinger-Westphal nucleus

C.&nbsp

Hypothalamus

D.&nbsp

Intermediolateral cell column

E.&nbsp

Superior cervical ganglion

21.

A 37-year-old man presents with vertigo,nystagmus,ataxia,andhearing loss in his right ear.MRI shows a tumor in the cerebel-lopontine angle.A biopsy specimen of this tumor indicates thatthis mass most likely originated from myelin-forming cells onthe root of the vestibulocochlear nerve.Which of the followingterms most correctly identifies this tumor?

A.&nbsp

Acoustic neuroma

B.&nbsp

Ependymoma

C.&nbsp

Glioblastoma multiforme

D.&nbsp

Meningioma

E.&nbsp

Vestibular schwannoma

22.

An inherited (autosomal recessive) disorder may appear early inthe teenage years.These patients have degenerative changes inthe spinocerebellar tracts,posterior columns,corticospinal fibers,cerebellar cortex,and at select places in the brainstem.The symp-toms of these patients may include ataxia,paralysis,dysarthria,and other clinical manifestations.This constellation of deficits ismost characteristically seen in which of the following?

A.&nbsp

Friedreich ataxia

B.&nbsp

Huntington disease

C.&nbsp

Olivopontocerebellar degeneration (atrophy)

D.&nbsp

Parkinson disease

E.&nbsp

Wallenberg syndrome

23.

A 45-year-old man complains to his family physician that thereseems to be something wrong with his mouth.The examina-tion reveals a weakness of the masticatory muscles,a deviationof the jaw to the left on closure,and a sensory loss on the sameside of the lower jaw.MRI shows a tumor,presumably a trigem-inal schwannoma,in the foramen ovale.Compression of whichof the following structures would most likely be the cause ofthe deficits experienced by this man?

A.&nbsp

Maxillary and mandibular nerves and motor fibers onthe left

B.&nbsp

Motor fibers and mandibular nerve on the left

C.&nbsp

Motor fibers and mandibular nerve on the right

D.&nbsp

Motor fibers and maxillary nerve on the left

E.&nbsp

Motor fibers and maxillary nerve on the right

24.

A 49-year-old man visits his ophthalmologist with what theman interprets as “trouble seeing.”The history reveals that theman had a sudden event a few days before in which he felt sickand was nauseated.The man said his trouble “seeing”startedafter this sudden sickness.The examination reveals a loss ofabduction and adduction of the right eye and a loss of adduc-tion of the left eye.MRI confirms an infarcted area in the cau-dal and medial pontine tegmentum.Which of the followingmost specifically identifies this man’s clinical problem?

A.&nbsp

Horizontal gaze palsy

B.&nbsp

Internuclear ophthalmoplegia

C.&nbsp

One-and-a-half syndrome

D.&nbsp

Parinaud syndrome

E.&nbsp

Vertical gaze palsy

25.

Collaterals of ascending anterior (ventral) trigeminothalamicfibers that contribute to the vomiting reflex would most likelyproject into which of the following brainstem structures?

A.&nbsp

Dorsal motor vagal nucleus

B.&nbsp

Facial nucleus

C.&nbsp

Nucleus ambiguous

D.&nbsp

Superior salivatory nucleus

E.&nbsp

Trigeminal motor nucleus

26.

The topographical arrangement of fibers in the medial lemnis-cus at mid-olivary levels is such that the sensory informationbeing conveyed by those fibers located most anterior (ventral)in this bundle will eventually terminate in which of the follow-ing structures?

A.&nbsp

Anterior paracentral gyrus

B.&nbsp

Lateral one-third of the postcentral gyrus

C.&nbsp

Medial one-third of the postcentral gyrus

D.&nbsp

Middle one-third of the postcentral gyrus

E.&nbsp

Posterior paracentral gyrus

27.

An 11-year-old girl is brought to the family physician by hermother.The mother explains that the girl has been complain-ing that her hands and arms “feel funny.”In fact,the motherstates that the girl cut her little finger,but did not realize ituntil she saw blood.The examination reveals a bilateral loss ofpain and thermal sensation on the upper extremities and shoul-der.Which of the following is the most likely cause of thisdeficit in this girl?

A.&nbsp

Brown-Séquard syndrome

B.&nbsp

Posterior inferior cerebellar artery syndrome

C.&nbsp

Tabes dorsalis

D.&nbsp

Syringobulbia

E.&nbsp

Syringomyelia

28.

A 57-year-old obese man is brought to the emergency depart-ment by his wife.The examination reveals that cranial nervefunction is normal but the man has bilateral weakness of his lower extremities.He has no sensory deficits.MRI shows asmall infarcted area in the general region of the cervical spinalcord–medulla junction.Which of the following represents themost likely location of this lesion?

A.&nbsp

Caudal part of the pyramidal decussation

B.&nbsp

Lateral corticospinal tract on the left

C.&nbsp

Pyramids bilaterally

D.&nbsp

Pyramid on the right

E.&nbsp

Rostral part of the pyramidal decussation

29.

A 34-year-old woman presents with the complaint of seeing “two ofeverything”(diplopia).The history reveals that the woman becomestired during the work day to the point where she frequently mustleave her work place early.The woman said that her vision prob-lems appeared first,and later she noticed that,when she drank,itwould “go down the wrong pipe.”The examination reveals weak-ness of the ocular muscle,difficulty in swallowing (dysphagia),andmild weakness of the upper extremities.Sensation is normal.Further laboratory tests indicate that the woman has a neurotrans-mitter disease.
Based on the history and symptoms experienced by thiswoman,which of the following is the most likely cause of hermedical condition?

A.&nbsp

Amyotrophic lateral sclerosis

B.&nbsp

Huntington disease

C.&nbsp

Myasthenia gravis

D.&nbsp

Multiple sclerosis

E.&nbsp

Parkinson disease

30.

A 34-year-old woman presents with the complaint of seeing “two ofeverything”(diplopia).The history reveals that the woman becomestired during the work day to the point where she frequently mustleave her work place early.The woman said that her vision prob-lems appeared first,and later she noticed that,when she drank,itwould “go down the wrong pipe.”The examination reveals weak-ness of the ocular muscle,difficulty in swallowing (dysphagia),andmild weakness of the upper extremities.Sensation is normal.Further laboratory tests indicate that the woman has a neurotrans-mitter disease.
Which of the following represents the most likely location ofthe neurotransmitter dysfunction in this woman?

A.&nbsp

At the termination of corticonuclear fibers

B.&nbsp

At the termination of corticospinal fibers

C.&nbsp

At the neuromuscular junction

D.&nbsp

Within the basal nuclei

E.&nbsp

Within the cerebellum

31.

A 34-year-old woman presents with the complaint of seeing “two ofeverything”(diplopia).The history reveals that the woman becomestired during the work day to the point where she frequently mustleave her work place early.The woman said that her vision prob-lems appeared first,and later she noticed that,when she drank,itwould “go down the wrong pipe.”The examination reveals weak-ness of the ocular muscle,difficulty in swallowing (dysphagia),andmild weakness of the upper extremities.Sensation is normal.Further laboratory tests indicate that the woman has a neurotrans-mitter disease.
Which of the following represents the neurotransmitter mostlikely affected in this woman?